Active NPI
Hussam Jaber
- General Practice Dentistry
- Green Bay, WI
National Provider Identifier
1063301653
On this page
Key facts
NPPES NPI Registry- Primary specialty
- General Practice Dentistry
- License
- 6001893-15
- Practice address
- 1551 Park PL Ste 300
Green Bay, WI 54304-1969 - Phone
- (773) 551-9490
- NPI assigned
- Jun 30, 2025
- Sex
- Male
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| General Practice Dentistry | 1223G0001X | 6001893-15 | WI | Primary |
Addresses
Primary practice location
1551 Park PL Ste 300
Green Bay, WI 54304-1969
Mailing address
1304 8TH St
Rockford, IL 61104-4913
Phone (708) 856-9766
Medicare participation
Medicare enrollment files- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
National Provider Directory- Medicare enrollment (NPD)
- Not enrolled
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 6001893-15 | WI | MD | General Practice Dentistry |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1751241600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1751241600000",
"number": "1063301653",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "1304 8TH ST",
"city": "ROCKFORD",
"state": "IL",
"postal_code": "611044913",
"telephone_number": "708-856-9766"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "1551 PARK PL STE 300",
"city": "GREEN BAY",
"state": "WI",
"postal_code": "543041969",
"telephone_number": "773-551-9490"
}
],
"practiceLocations": [],
"basic": {
"last_name": "JABER",
"first_name": "HUSSAM",
"sole_proprietor": "YES",
"sex": "M",
"enumeration_date": "2025-06-30",
"last_updated": "2025-06-30",
"certification_date": "2025-06-30",
"status": "A"
},
"taxonomies": [
{
"code": "1223G0001X",
"taxonomy_group": "",
"desc": "Dentist, General Practice",
"state": "WI",
"license": "6001893-15",
"primary": true
}
],
"identifiers": [],
"endpoints": [],
"other_names": []
}Other providers in Green Bay, WI
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 30, 2025; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.